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Full text of "Navy & Marine Corps Medical News 00-12"

The United States Navy on the World Wide Web 
A service of the Navy Office of Information, Washington DC 
send feedback/questions to coinments@chinfo.navy.mil 
The United States Navy web site is found on the Internet at 

http: //www. navy.mil 



Navy & Marine Corps Medical News 

MN-00-12 

March 24, 2000 

The Navy Bureau of medicine and Surgery distributes Navy 
and Marine Corps Medical News (MEDNEWS) to Sailors and 
Marines, their families, civilian employees and retired 
Navy and Marine Corps families . To achieve maximum medical 
information distribution, your command is highly encouraged 
to distribute MEDNEWS to ALL HANDS electronically, include 
MEDNEWS in command newspapers, newsletters and radio and TV 
news programs. 

Stories in MEDNEWS use these abbreviations after a Navy 

medical professional' s name to show affiliation : MC - 
Medical Corps (physician) ; DC - Dental Corps; NC - Nurse 
Corps; MSC - Medical Service Corps (clinicians, researchers 
and administrative managers) . Hospital Corpsmen (HM) and 
Dental Technician (DT) designators are placed in front of 
their names. 

-USN- 

Contents for this week's MEDNEWS: 

Headline: Hearing loss a readiness issue (photos) 
Headline: New approaches to preventing hearing loss 

Headline: Carrier' s first physical therapist is no pain in the neck 
(photo) 

Headline: Research seeks answer to spatial disorientation problems 

Headline: Exceptional Family Member Program gets new instructions 

Headline: Great Lakes blood bank accredited 

Headline: Anthrax question and answer 

Headline: TRICASE question and answer 

Headline: Healthwatch: Oral cancer: are you at risk? 

-USN- 

Headline: Hearing loss a readiness issue (photo) 

By Capt . Jane F. Vieira, CHC, Naval Sea Systems Command 

CRYSTAL CITY, Va. — Hearing as a readiness issue, with 
focus on noise-induced hearing problems were the topics of 
the Navy's first syn^osium on hearing loss held Feb. 4th at 
Naval Sea Systems Command. 

More than 20 military and civilian experts in research 
audiology and acoustics engineering from across the country 
met to address and seek solutions to the impact of noise on 
operational readiness aboard surface ships. 

The conference looked at the effect of noise on 
performance and safety as well as how the problem concerns 
the entire spectrum of naval personnel. 



Subject matter experts presented studies demonstrating 
that many Sailors leave the Navy with significant hearing 
loss and that 282, 000 service members currently collect 
compensation for hearing damage. 

Vice Adm. Pete Nanos, commander. Naval Sea Systems 
Command said noise impacts the readiness of the Navy in 
many ways: poor or lost communications, sleep deprivation, 
fatigue, reduced alertness, safety, retention, morale, 
habitability, as well as short and long term hearing loss. 

Nanos said hearing conservation is an issue of 
readiness, safety, health and quality of life. Fixing this 
problem is an ethical and leadership issue, and it is the 
right thing to do. 

Hearing stress, which is measured in decibels, increases 
on a logarithmic scale. Symposium experts demonstrated how 
the majority of sounds encountered by military personnel 
potentially fall within a dangerous range of sound pressure 
levels . 

Continuous background noise, as experienced on most 
surface ships, begins hearing stress. Additional noise 
peaks, such as firing weapons or aircraft launches, 
superimposed on continuous background noise can cause even 
greater damage. Hearing research has also concluded that 
humans adapt to higher noise levels, and consequently 
become accustomed to harmful sound levels. 

While hearing has been viewed as more of a health or 
quality of life issue, existing data increasingly suggest 
it is also a significant operational readiness concern. 
Aboard aircraft carriers, the steady and intermittent 
noises created by launching and recovering aircraft 24- 
hours—a—day produce deafening noises from jet engines at 
full power, arresting gear machinery, arresting cable slap, 
catapult launches, waterbrakes and more. 

Better hearing protection devices, currently being 
deployed, was one of the solutions to the problem of noise 
on surface ships presented at the conference. Discussions 
also included the use of pharmacological methods to prevent 
and reverse hearing loss. 

These methods are in pre— clinical trials and appear to 
offer exciting and cost-effective strategies to reduce 
permanent hearing loss from excessive noise. Acoustic 
technology is also providing solutions, especially in the 
commercial arena . 

Quiet fans and motors, new insulation materials, 
laminated sheet metal, better joiner systems, and effective 
communication earpieces are all being used commercially in 
active noise control efforts. 

Nanos challenged those at the symposium to raise the 
priority of hearing loss prevention with completed studies 
and data assimilation. 

"NAVSEA' s goal for the 21st century is not only to 
eliminate the impact of noise as a factor in operational 
readiness and to increase shipboard quality of life, but to 
do our part in keeping Sailors and Marines out of hearing 



conservation programs rather than just preventing hearing 
loss, " he said. 

-USN- 

Headline : New approaches to preventing hearing loss 

By Col. Richard Kopke, MC, USA, Naval Medical Center San 

Diego 

SAN DIEGO — Traditional approaches to prevent hearing 
loss in military settings have included efforts to engineer 
weapons systems and work spaces to be quieter, personal 
protection devices, and hearing conservation programs. 
Considerable reduction in noise— induced hearing loss has 
occurred since WW II. 

Still, there are physical and human factors which reduce 
the effectiveness of personal hearing protection devices 
such as transmission of sound energy through the skull 
directly to the inner ear, the need for a perfect seal of 
the protective device, discomfort, and the element of 
surprise . 

These are some of the compelling reasons why a 
pharmacological approach to preventing or reversing noise- 
induced hearing loss may be attractive . This approach 
involves making the inner ear more resistant to noise 
through the use of antioxidant compounds, or in some cases 
reversing hearing loss using rescue agents. 

Most military personnel are exposed to damaging levels 
of noise during defined periods of training such as weapons 
training, flight operations, live fire exercises or duty in 
engine rooms. The antioxidant compounds could be given to 
personnel around the time of such exposures along with 
mechanical protectors. The combination would more 
effectively reduce permanent hearing loss. 

Another approach would be to closely monitor hearing 
levels and administer rescue agents to those personnel who 
develop hearing loss over these defined periods of intense 
noise exposure. This would enhance the ear's ability to 
recover and rest prior to further noise exposures. 

-USN- 

Headline: Carrier' s first physical therapist is no pain in 

the neck (photo) 

By JOl (AW) John Joyce 

USS GEORGE WASHINGTON (CVN 73) — "As a newly hired 
physical therapist at a civilian hospital or clinic, I 
would step into a wonderful office and inherit a pre- 
established physical therapy program," said Lt. Janice 
Rinkel, USS George Washington' s (CVN 73) first physical 
therapist . "That would be comfortable. But I'm still kind 
of an adventurous person and that's why I'm here." 

"The adventure of coming aboard a great warship and the 
chance to say, ^hey, I get to set up this clinic, ' is a 
great challenge but it's a challenge I feel I'm up to," 
said Rinkel. 

She checked aboard the "Spirit of Freedom" in November 



of 1999 as part of a Bureau of Medicine and Surgery five- 
year trial, which incorporates physical therapy into 
medical programs aboard aircraft carriers. 

"J wasn't surprised when my detailer gave me two days to 
decide which of two carriers I would choose, " Rinkel said. 
"X knew the new initiative to put a physical therapist on 
each carrier was coming. I knew of GW s great reputation 
and looked at it as an opportunity to experience life at 
sea, something my medical colleagues in Portsmouth have not 
been able to do." 

Rinkel' s new billet is also an opportunity for GW 
Sailors to receive needed physical therapy within one to 
two days conveniently aboard ship rather than dealing with 
traffic, and an average of two to three weeks waiting for 
an appointment at a local hospital or clinic. 

"J don't think a lot of people know that I'm on the ship 
yet," said Rinkel. "When patients are referred to me by a 
physician' s assistant or general medical officer, they are 
amazed and say, 'J can actually come here for treatment 
aboard ship rather than battle traffic to a clinic!" 

Rinkel' s mission aboard extends beyond reducing lost 
product ivity. 

"If I can do some simple adjustments on a Sailor' s back 
and get him or her off light duty within one or two days 
versus two weeks, it will do more than save man-hours, " she 
said. "It will eliminate pain. You can see the relief on 
their faces. They are not dealing with the pain or taking 
Motrin any longer. The fact that Sailors are happier and 
healthier makes a big difference to job performance and the 
overall mission of the ship. " 

Keeping GW Sailors happier and healthier without 
protracted follow— up visits is another goal that Rinkel 
hopes to achieve, and she plans to do it by applying a 
common medical principle — prevention. She's been 
practicing the principle since running track in high 
school . 

"What really struck me when I ran track in high school 
was that sports medicine dealt with the whole body, " said 
Rinkel . "Aboard GW, we will also prevent injuries in that 
way with stretching exercises, muscle re-education and 
strengthening . If a Sailor needs physical conditioning, we 
have gyms aboard ship with machines and free weights that 
will do that as well . A technician will soon be coming 
aboard to assist with treatment and the strength and 
conditioning programs . " 

Preventive medicine classes and a preventive medicine 
folder on the LAN are two ways Rinkel proposes to increase 
awareness about preventing injury aboard ship. 

"After only two-and-a-half months aboard GW, I've 
already seen some things that can be changed for the 
better," said Rinkel. "I've seen what people go through on 
the ship and what the typical injuries are. We can prevent 
a lot of chronic neck and back pain if Sailors would modify 
what they do. We'll take a look at workstations, exercise 



equipment, and running shoes. I'll post information on the 
LAN that anybody can pull up explaining how to order the 
correct shoes. That alone will decrease a lot of knee 
pain. We'll show people what to do if their back hurts and 
educate them on the correct way to work out. In effect, 
we'll give people the tools and know— how to treat 
themselves . " 

-USN- 

Headline: Research seeks answer to spatial disorientation 
problems 

By Doris Ryan, Bureau of Medicine and Surgery 

WASHINGTON — By capitalizing on a pilot's innate sense 
of touch. Navy medical researchers are solving the problem 
of spatial disorientation. Their work can mean a major 
breakthrough in aviation safety — the payoff is lives 
saved. 

In 1989 Capt. Angus H Rupert, MC, a Navy flight surgeon 
first proposed a non-visual solution to provide intuitive 
spatial orientation — the Tactile Situation Awareness 
System (TSAS) . Using touch in concert with vision, pilots 
would constantly know where down is. 

The cause of spacial disorientation in flight is 
biological according to Rupert, who is the principle 
investigator on the project at the Naval Aerospace Medical 
Research Laboratory in Pensacola, Fla. 

"On the ground, in our day-to-day activities, spatial 
orientation is continuously maintained by accurate 
information from three independent, redundant, and 
concordant sensory systems — vision, the vestibular system 
(inner ear) , and the somatosensory system (skin, muscle, 
joints) . We walk upright without giving a second thought 
to the complex processes at play within our bodies. 

The research team, which based its technology on biology 
and basic human senses, designed a prototype computer and 
lightweight flight vest that translates digital information 
from the aircraft' s orientation instruments into 
vibrations . The pilot feels the vibrations from tactile 
stimulators sewn into a flight vest . Touch becomes a 
continuous spatial orientation cue. 

The flight vest lets the pilot know where the ground is 
at all times. The pilot literally feels the orientation 
with respect to the ground. For example, a vibration near 
the right shoulder means the aircraft banked right at 90 
degrees, a vibration lower under the arm indicates a 45- 
degree right bank. A vibration at the navel indicates the 
aircraft' s nose is down. 

Rupert said, "TSAS has the capability of providing a 
wide variety of flight parameter information, for exaiaple, 
attitude, altitude, velocity, navigation, acceleration and 
threat location. TSAS, integrated with visual and audio 
display systems will provide the right information at the 
right time by the right sensory channels and represents the 
next generation human systems interface for tactical 



aircraft . " 

For more information about TSAS and other Naval 
Aerospace Medical Research projects, visit the web site at 
http://wmr.namrl.navy.mil/ . 

-USN- 

Headline: Great Lakes blood bank accredited 

By Lt . Youssef H. Aboul—Enein, MSG, Naval Hospital Great 

Lakes 

Great Lakes, 111. - Cmdr. Kenneth W. Sapp, MC, head of 
the Clinical Laboratory Department, announced recently that 
the blood bank and blood donor center of the naval hospital 
has been accredited by the American Association of Blood 
Banks . 

The association is a worldwide organization that is 
dedicated to the highest standards of excellence in blood 
collection and transfusion. Founded in 1947, the 
association is a voluntary professional society of almost 
9, 000 members and an institutional membership of more than 
2, 000 community, regional and hospital based blood bank 
activities . 

"Accreditation is a major accomplishment that it 
recognized around the world." said Lt . Cmdr. Stephan F. 
Jun, MC, medical director of the blood bank and donor 
center. It involves the successful completion of a 
rigorous on-site inspection by an outside assessor who has 
been specifically trained and by the association . 

"It is quite an honor for our blood bank and donor 
center." said Lt. Roland L. Fahie, MSG, director of the 
Midwest Region of the Navy Blood Program. "The real credit 
goes to our blood bank and donor center staff; Hospital 
Corpsman 1st Class Jeff Diffy; Hospital Corpsmen 2nd Class 
Robert Neumann and Lee Witter; Hospital Corpsmen 3rd Class 
Sandia Valdez, Robert Evans, Bill Lewandowski, and others. 
It was their outstanding efforts and personal dedication to 
excellence that resulted in a successful inspection and 
accreditation . " 

-USN- 

Headline: Exceptional Family Member Program gets new 
instructions 

By Tom Marko, Bureau of Medicine and Surgery 

WASHINGTON — Navy Surgeon General Vice Adm. Richard A. 
Nelson signed a totally revised instruction addressing the 
Suitability Screening and Exceptional Family Member 
programs. BUMED Instruction 1300.2, 17 Feb 00, "Medical, 
Dental, and Educational Suitability Screening and 
Exceptional Family Member Program Enrollment " is now policy 
and includes the following changes: 

- Cancels NAVMEDCOMINST 1300. IC, 23 Mar 89. 

- Provides comprehensive policy and procedures medical, 
dental, and educational screening for overseas, remote duty 
and operational assignments 

- Provides comprehensive EFMP enrollment procedures. 



- Replaces NAVMED Form 1300/1 (Rev. 8-99) (Test) with 
NAVMED Form 1300/1 (Rev. 2-00) . 

- Replaces SF 600 overprint with NAVMED Form 1300/2 
(rev. 2-00) . 

- Incorporates interim message guidance and women 's 
health care policy issued since March 1989. 

- Eliminates the pregnancy test requirement 30 days 
prior to transfer . 

- Requires screening after periods of temporary limited 
duty and finding of "fit for continued Naval service" by a 
Physical Evaluation Board. 

- Addresses special screening requirements 

- Adds guidance on early intervention, special education 
and civilian employee screening. 

BUMED Instruction 1300.2 is available for download at 
http : //navymedicine. med.navy.mil/instructions/external/exte 
rnal/htm. 

If you have any questions concerning the instruction, 
contact Tom Marko (MED-31BAS) at TLMarko@us.med.navy.mil; 
DSN 762-3107 . For operational assignments, contact CAPT 
Jay Montgomery at JRMontgomery@us.med.navy.mil. Phone DSN 
762-3466. 

-USN- 

Headline: Anthrax question and answer 
From Bureau of Medicine and Surgery 

Question: Why will it take the DoD and Coast Guard so 
long to vaccinate the total force? 

Answer: There is not enough vaccine to vaccinate 
everyone at once. Therefore, the DoD has a phased— 
implementation program, starting with personnel in high- 
threat areas. Applying any program, procedures or process 
to the entire U.S. military force is a complicated and 
expensive process that must be thoroughly planned and 
carefully executed to achieve the desired results. 
Protection against anthrax is particularly challenging 
because the vaccination protocol requires multiple doses to 
achieve immunity, and thus involves significant 
administrative and logistical issues. 

For more information visit the Navy anthrax web site at 
http: www-nehc . med . navy . mi 1/prevmed/immun/ anthrax .htm, or 
the DOD anthrax web site at http://www.anthrax.osd.mil/. 

-USN- 

Headline: TRICARE question and answer 
From Bureau of Medicine and Surgery 

Question: Does the copayment increase for the emergency 

room? 

Answer: There are no out-of-pocket costs for any care 
received at a military hospital, including emergency room 
care. The out-of-pocket costs for care received at a 
civilian emergency room for families of E—4 and below 



enrolled in Prime is $10. For families of E-5 and above 
and retirees and their families, the copay for an emergency 
room visit is $30. 

This single payment, $10 or $30, includes all emergency 
room services provided in conjunction with the visit. For 
those who have chosen to remain in TRICARE Standard, or use 
the TRICARE Extra program, their regular deductibles and 
copayments apply. 

For more information visit the TRICARE web site at 
http: //www. tricare.osd.mil 

-USN- 

Headline: Healthwatch: Oral cancer: are you at risk? 
From Bureau of Medicine and Surgery 

WASHINGTON — The most common form of oral cancer is 
known as squamous cell carcinoma. It classically develops 
as a crater-like lesion having a velvety red base with 
rough edges similar to a very bad "pizza burn. " However, 
it may appear as white patches, with some irregular red 
patches, mixed together in its earlier stages. 

An important aspect of squamous cell carcinoma is its 
location within the mouth. The lower lip and the tongue 
are the most frequent sites with the floor of the mouth not 
far behind. 

Lesions are usually solitary but in some cases have been 
found to occur in groups. The concern with the location is 
that certain areas allow the cancer an easier route to 
spread to other parts of the body, metastasize, and lessen 
chances for a good prognosis . Lesions found on the back 
third of the tongue have the greatest chance to 
metastasize, usually to lymph nodes in the neck. 

As with most cancers we still don 't know everything 
there is to know about what causes squamous cell carcinoma, 
but we do know what increases the risks of developing it. 

The use of tobacco products (smoking, snuff, pipe, 
cigar, etc.) is a major risk factor, but also the use of 
alcohol products has been found to increase the risks of 
developing the cancer. 

When these two risk factors are put together, it becomes 
the greatest risk factor. This is why the highest 
occurrence of oral cancer is found in the middle— aged to 
elderly male population who have a history of tobacco and 
or alcohol use. 

The treatment of squamous cell carcinoma depends on 
several factors: time of detection, size of tumor, spread 
of tumor, etc. Treatments may range from surgical removal 
of the tumor, radiation of the tumor or chemotherapy. Most 
occurances will require a combination of these treatments . 

The overall 5-year survival rate for all oral cancer 
patients is about 40%. This percentage is getting better 
as we are detecting the cancer earlier and educating 
patients to the risk factors associated with the cancer. 

It is very important that patients periodically examine 
their mouths for any changes that could be associated with 



oral cancer. A self-exam is fairly simple and could save a 
patient's life. It must be understood that there is very 
little, if any, pain associated with oral cancer until the 
very late stages. Therefore, it is imperative that people 
routinely stand in front of the mirror and actually take a 
look inside of their mouth. 

Use a mirror with good lighting, open your mouth wide 
enough to see all of your teeth and the back of your 
throat . A good time to do this is right after you brush 
your teeth. Look at the insides of your cheeks, the roof 
of your mouth, your tongue (especially the sides as far 
back as possible) , the floor of your mouth, your gums and 
the inside of both of your lips. 

Note anything that appears to be an odd color, texture, 
or shape especially when it is only found on one side of 
your mouth . Keep in mind that early signs of squamous cell 
carcinoma usually show up as white or red patches or some 
combination . 

Should you find anything suspicious, schedule an 
appointment with your dentist for a professional exam, 
especially if you fall into one of the high risk groups 
(use of tobacco and or alcohol) . Your dentist should 
examine an ulcer in your mouth that doesn't heal within two 
weeks. Dentists routinely do an oral cancer screening upon 
your normal check-ups , but do not neglect to do a self-exam 
on your own mouth at least once a week. 

Remember, the earlier that squamous cell carcinoma is 
detected, the better the prognosis . As with all oral 
health concerns, prevention is the key to success. 

-USN- 

Comments about and ideas for MEDNEWS are welcome. Story 
submissions are encouraged. Contact MEDNEWS editor. Earl 
W. Hicks, at email: mednews@us.med.navy.mil; Telephone 
202/762-3223, (DSN) 762-3223, or fax 202/762-3224. 

-USN- 

-USN-